Cohn S M, Burns G A, Jaffe C, Milner K A
Department of Surgery, Yale University School of Medicine, New Haven, Connecticut, USA.
J Trauma. 1995 Dec;39(6):1087-90. doi: 10.1097/00005373-199512000-00013.
The goal of this study was to investigate the value of biplanar transesophageal echocardiography (TEE) as a screening tool for aortic tear in unstable trauma patients.
During a 1-year period, a prospective trial to exclude aortic tear was conducted at a level I trauma center. Ten of 53 patients (19%) sustaining severe blunt thoracic trauma were deemed too unstable to undergo safe transport to aortography and underwent TEE. Mechanism of injury was motor vehicle crash in eight patients and pedestrians struck in two. Patients had a mean Injury Severity Score = 34 (range, 17 to 59) and mean age = 43 years (range, 18 to 77). Indications for aortic tear evaluation were chest x-ray findings in seven and mechanism of injury alone in three. Patients were not transportable because of hemodynamic instability in five individuals, severe unstable head injury in three individuals, and unstable cervical spine fracture in two individuals.
Transesophageal echocardiography was performed in the emergency department in one instance, in the operating room in one instance, and in the surgical intensive care unit in the remaining eight instances. Patients underwent the procedure less than 8 hours after admission in seven and more than 48 hours after admission in three. One patient had a complication during TEE (ventricular dysrhythmias). In one of ten patients, TEE was positive. This patient required medical management (beta-blockade) for aortic tear until severe hypoxia secondary to pulmonary contusion improved after 36 hours. Repair of aortic tear was then successfully performed.
The TEE procedure is valuable in identifying aortic injury in high-risk trauma patients who are too unstable to undergo transport to the aortography suite.
本研究的目的是探讨双平面经食管超声心动图（TEE）作为不稳定创伤患者主动脉撕裂筛查工具的价值。
在1年的时间里，在一级创伤中心进行了一项排除主动脉撕裂的前瞻性试验。53例遭受严重钝性胸部创伤的患者中有10例（19%）被认为病情过于不稳定，无法安全转运至主动脉造影检查，因此接受了TEE检查。损伤机制为8例机动车碰撞伤和2例行人撞击伤。患者的平均损伤严重度评分=34（范围17至59），平均年龄=43岁（范围18至77）。评估主动脉撕裂的指征为7例患者的胸部X线检查结果和3例患者仅根据损伤机制。5例患者因血流动力学不稳定、3例患者因严重不稳定的头部损伤、2例患者因不稳定的颈椎骨折而无法转运。
TEE检查在急诊室进行了1例，在手术室进行了1例，其余8例在外科重症监护病房进行。7例患者在入院后8小时内接受了该检查，3例患者在入院后48小时以上接受了该检查。1例患者在TEE检查期间出现并发症（室性心律失常）。10例患者中有1例TEE检查结果为阳性。该患者因主动脉撕裂需要药物治疗（β受体阻滞剂），直到36小时后肺挫伤继发的严重缺氧情况改善。随后成功进行了主动脉撕裂修复术。
对于病情过于不稳定而无法转运至主动脉造影检查室的高危创伤患者，TEE检查在识别主动脉损伤方面具有重要价值。
